The prefrontal dysfunction in individuals with Internet gaming disorder: a meta-analysis of functional magnetic resonance imaging studies
Abstract
With the advancement in high-resolution magnetic resonance imaging (MRI) technology and automated analysis, studies on functional MRI (fMRI) made it possible to identify the functional activity of brain in vivo in individuals with Internet gaming disorder (IGD), and to explore the underpinning neuroscience basis of IGD. Yet, no available literature has systemically reviewed the fMRI studies of IGD using meta-analyses. This study reviewed 61 candidate articles and finally selected 10 qualified voxel-wise whole-brain analysis studies for performing a comprehensive series of meta-analyses employing effect size signed differential mapping approach. Compared with healthy controls, subjects with IGD showed a significant activation in the bilateral medial frontal gyrus (MFG) and the left cingulate gyrus, as well as the left medial temporal gyrus and fusiform gyrus. Furthermore, the on-line time of IGD subjects was positively correlated with activations in the left MFG and the right cingulated gyrus. These findings implicate the important role of dysfunctional prefrontal lobe in the neuropathological mechanism of IGD. Considering the overlapped role of prefrontal lobe in the reward and self-regulatory system, our results provided supportive evidence for the reclassification of IGD as a behavioural addiction.
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The proposed imbalance between limbic/reward-oriented brain circuits and prefrontal control in behavioral addictions has been reviewed relatively extensively for gambling disorder and gaming disorder, including in meta-analyses.
“The aforementioned proposed imbalance between limbic/ rewardoriented brain circuits and prefrontal control in behavioral addictions has been reviewed relatively extensively for gambling disorder (Clark et al., 2013; Goudriaan et al., 2014; Potenza, 2013; van Holst et al., 2010) and gaming disorder (Kuss et al., 2018; Weinstein, 2017; Weinstein et al., 2017), including in meta-analyses (Meng et al.”
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“IGD is associated with negative measures including psychiatric disorders, social deficits, and poor academic performance (Meng et al., 2014; Petry et al., 2014).”
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“Some studies have even documented possible biomarkers for this condition [12].”
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“Internet gaming disorder (IGD), also known as Internet addiction disorder (pathological Internet use), is defined as persistent and recurrent use of the Internet to engage in games, which may lead to significant psychological distress and interfere with daily social life [2].”
BackgroundLei, H., Cheong, C. M., Li, S., & Lu, M. (2018) · Psychiatry Research · doi:10.1016/j.psychres.2018.10.079 · Cited by 72 · see citing works
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“Given the higher prevalence of IGD in males (Meng et al., 2015) and gender-related differences related to craving (Dong et al.”
BackgroundLi, W., Li, Y., Yang, W., Zhang, Q., Wei, D., Li, W., Hitchman, G., & Qiu, J. (2015) · Neuropsychologia · doi:10.1016/j.neuropsychologia.2015.02.019 · Cited by 69 · see citing works
“Furthermore, the symptom severity (the on-line time) was associated with activations in the left MFG (dorsolateral prefrontal cortex) and the right cingulate gyrus (Meng et al., 2014).”
BackgroundThe neurobiology of addiction: the perspective from magnetic resonance imaging present and future
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“addictive behaviours towards internet gaming [39].”
The Cambridge Handbook of Substance and Behavioral Addictions
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Reduced fiber integrity and cognitive control in adolescents with internet gaming disorder
Xing, L., Yuan, K., Bi, Y., Yin, J., Cai, C., Feng, D., Li, Y., Song, M. K., Wang, H., Yu, D., et al. (2014) · Brain Research · doi:10.1016/j.brainres.2014.08.044 · Cited by 62 · see citing works
“…framework (Christakis, 2010; Yuan et al., 2011a), the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) identified IGD in Section 3 as a condition warranting more clinical research to provide mechanistic insight into its etiology and treatment (Meng et al., 2014).”
BackgroundSelf-citationHan, X., Wang, Y., Jiang, W., Bao, X., Sun, Y., Ding, W., Cao, M., Wu, X., Du, Y., & Zhou, Y. (2018) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2018.00341 · Cited by 60 · see citing works
Choi, J., Cho, H., Kim, J.-Y., Jung, D. J., Ahn, K. J., Kang, H.-B., Choi, J., Chun, J., & Kim, D. (2017) · Scientific Reports · doi:10.1038/s41598-017-01275-5 · Cited by 57 · see citing works
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Klugah‐Brown, B., Zhou, X., Pradhan, B., Zweerings, J., Mathiak, K., Biswal, B. B., & Becker, B. (2021) · Addiction Biology · doi:10.1111/adb.12997 · Cited by 56 · see citing works
“previous meta-analysis on IGD reported temporal as well as frontal alterations, specifically during higher-level cognitive processes such as executive control.(25,50)”
Brand, M., Rumpf, H.-J., Demetrovics, Z., King, D. L., Potenza, M. N., & Wegmann, E. (2019) · Current Addiction Reports · doi:10.1007/s40429-019-00258-y · Cited by 53 · see citing works
Altered Structural Correlates of Impulsivity in Adolescents with Internet Gaming Disorder
Du, X., Qi, X., Yang, Y., Du, G., Gao, P., Zhang, Y., Qin, W., Li, X., & Zhang, Q. (2016) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2016.00004 · Cited by 54 · see citing works
“It has also been reported that the dmPFC showed abnormal activation during performing cognitive task which contributed to self-regulation and impulse control processing in the subjects with IGD compared with healthy subjects (Meng et al., 2015).”
Wang, Y., Hu, Y., Xu, J., Zhou, H., Lin, X., Du, X., & Dong, G. (2017) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2017.00287 · Cited by 54 · see citing works
Dong, G., Wang, M., Wang, Z., Zheng, H., Du, X., & Potenza, M. N. (2019) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2019.109829 · Cited by 49 · see citing works
Alshehri, A. G., & Mohamed, A. M. A. S. (2019) · American Journal of Men s Health · doi:10.1177/1557988319873512 · Cited by 52 · see citing works
“Brain imaging studies reported significant changes in the areas of the brain that regulate impulse control and decision-making among individuals with Internet gaming disorder (Meng et al., 2015).”
BackgroundComparison of frontostriatal circuits in adolescent nicotine addiction and internet gaming disorder
von Deneen, K. M., Hussain, H., Waheed, J., Xinwen, W., Yu, D., & Yuan, K. (2022) · Journal of Behavioral Addictions · doi:10.1556/2006.2021.00086 · Cited by 51 · see citing works
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Aberrant corticostriatal functional circuits in adolescents with Internet addiction disorder
Lin, F., Zhou, Y., Du, Y., Zhao, Z., Qin, L.-D., Xu, J., & Lei, H. C. (2015) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2015.00356 · Cited by 47 · see citing works
“, 2012b) and a meta-analysis showed that IAD had a significant hyperactivation in medial frontal/ACC (Meng et al., 2014).”
BackgroundThe Prevention and Treatment of Gambling Disorders: Some Art, Some Science
Derevensky, J. L. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.024 · Cited by 45 · see citing works
Considering the Overlap and Nonoverlap of Compulsivity, Impulsivity, and Addiction
Blum, A. W., & Grant, J. E. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.038 · Cited by 44 · see citing works
Neurobiological Foundations of Behavioral Addictions
Vaccaro, A. G., & Potenza, M. N. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.016 · Cited by 45 · see citing works
Neurobiology of Substance Addictions
Christie, N. C., & Bechara, A. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.015 · Cited by 44 · see citing works
Sensitization of Incentive Salience and the Transition to Addiction
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Mindfulness-Based Interventions Applied to Addiction Treatments
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Multiple Memory Systems, Addiction, and Health Habits: New Routes for Translational Science
Stacy, A. W., Pike, J. R., & Lee, A. Y. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.017 · Cited by 43 · see citing works
Tanning as an Addiction: The State of the Research and Implications for Intervention
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Behavioral Economics and Addictive Disorders
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Prevention and Treatment of Compulsive Buying Disorder
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Prevention and Treatment of “Food Addiction”
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Human Neurobiological Approaches to Hedonically Motivated Behaviors
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Feedback Models for Gambling Control: The Use and Efficacy of Online Responsible Gambling Tools
Griffiths, M. D. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.034 · Cited by 42 · see citing works
Yan, W.-S., Chen, R.-T., Liu, M., & Zheng, D.-H. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.628933 · Cited by 43 · see citing works
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“In a meta-analysis of 61 studies, Meng et al. (2015) suggested that patients with IGD have dysfunctional prefrontal reward circuitry and self-regulatory systems.”
BackgroundMeta-analysis of structural and functional brain alterations in internet gaming disorder
Niu, X., Gao, X., Zhang, M., Yang, Z., Yu, M., Wang, W., Wei, Y., Cheng, J., Han, S., & Zhang, Y. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.1029344 · Cited by 42 · see citing works
“cognitive control (79), emotional regulation (80), rewardbased decision-making (81), conflict monitoring and error processing (82).”
BackgroundDeng, L., Liu, L., Xia, C., Lan, J., Zhang, J., & Fang, X. (2017) · Frontiers in Psychology · doi:10.3389/fpsyg.2017.00526 · Cited by 41 · see citing works
“Studies among IGD participants have implicated the relationship between dysfunction of inhibition control and addictive behaviors (Meng et al., 2014; Yao et al., 2015), and preliminarily demonstrated the effects of combined reality therapy and mindfulness meditation in reduction of decisional…”
BackgroundInfluentialDong, G., Liu, X., Zheng, H., Du, X.-X., & Potenza, M. (2019) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2019.03.003 · Cited by 37 · see citing works
Wegmann, E., Müller, S. M., Ostendorf, S., & Brand, M. (2018) · Current Behavioral Neuroscience Reports · doi:10.1007/s40473-018-0164-7 · Cited by 39 · see citing works
Wu, L., Zhu, L., Shi, X., Zhou, N., Wang, R., Liu, G., Song, K., Xu, L., Potenza, M. N., & Zhang, J. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.112892 · Cited by 38 · see citing works
Sun, J.-T., Hu, B., Chen, T.-Q., Chen, Z., Shang, Y., Li, Y., Wang, R., & Wang, W. (2023) · Brain Imaging and Behavior · doi:10.1007/s11682-023-00762-w · Cited by 38 · see citing works
“Meng(Meng et al., 2015) quantitatively summarized task-related functional magnetic resonance imaging (fMRI) studies by using a coordinate-based meta-analysis and found that patients with internet gaming disorder showed higher brain activation in the ACC.”
MethodGe, X., Sun, Y.-W., Han, X., Wang, Y., Ding, W.-N., Cao, M., Du, Y.-S., Xu, J.-R., & Zhou, Y. (2017) · BMC Neuroscience · doi:10.1186/s12868-017-0375-y · Cited by 35 · see citing works
“Background Internet gaming disorder (IGD), also known as problematic internet use, is the excessive and recurrent use of online internet games [1].”
BackgroundDanielsen, P. A., Mentzoni, R. A., & Låg, T. (2023) · Addictive Behaviors · doi:10.1016/j.addbeh.2023.107887 · Cited by 35 · see citing works
Antons, S., & Brand, M. (2020) · Journal of Behavioral Addictions · doi:10.1556/2006.2020.00010 · Cited by 37 · see citing works
Impulsivity and Difficulties in Emotional Regulation as Predictors of Binge-Watching Behaviours
Starosta, J., Izydorczyk, B., Sitnik‐Warchulska, K., & Lizińczyk, S. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.743870 · Cited by 37 · see citing works
Müller, S. M., Antons, S., Schmid, A. M., Thomas, T. A., Kessling, A., Joshi, M., Krikova, K., Kampa, M., Mallon, L., Schmidt, L. D., et al. (2025) · American Journal of Psychiatry · doi:10.1176/appi.ajp.20240486 · Cited by 32 · see citing works
“This also applies to initial neuroscientific studies indicating potential dysfunctions and alterations in (prefrontal) brain areas associated with executive control functioning in the context of gaming disorder (16, 17) and unspecified PUI (18).”
Altered Heart Rate Variability During Gaming in Internet Gaming Disorder
Lee, D., Hong, S. J., Jung, Y., Park, J., Kim, I. Y., & Namkoong, K. (2018) · Cyberpsychology Behavior and Social Networking · doi:10.1089/cyber.2017.0486 · Cited by 33 · see citing works
“11,12 Although studies have indicated executive control deficits in IGD, the results of the behavioral tasks measuring executive control were not consistent.”
Emotional bias modification weakens game-related compulsivity and reshapes frontostriatal pathways
Wu, L., Xu, J., Song, K., Zhu, L., Zhou, N., Xu, L., Liu, G., Wang, Z., Wang, R., Qin, S., et al. (2022) · Brain · doi:10.1093/brain/awac267 · Cited by 29 · see citing works
Disrupted inter-hemispheric functional and structural coupling in Internet addiction adolescents
Bi, Y., Yuan, K., Feng, D., Xing, L., Li, Y., Wang, H., Yu, D., Xue, T., Jin, C., Qin, W., et al. (2015) · Psychiatry Research Neuroimaging · doi:10.1016/j.pscychresns.2015.08.012 · Cited by 28 · see citing works
“Based on the PFC dysfunctions in previous IA studies (Brand et al., 2014; Meng et al., 2014), we hypothesize that the VMHC values of PFC and the integrity of the fiber connecting the bilateral hemisphere would be abnormal and these changes would be correlated with duration and severity of IA.”
BackgroundSelf-citationPark, S. M., Lee, J. Y., Choi, A. R., Kim, B. M., Chung, S. J., Park, M., Kim, I. Y., Park, J., Choi, J., Hong, S. J., et al. (2019) · Addiction Biology · doi:10.1111/adb.12805 · Cited by 27 · see citing works
“The present finding that an increased theta CPL was indicative of decreased network efficacy in IGD patients after adjusting for IQ supports the findings of numerous previous studies that investigated disrupted functional connectivity in this population.(66) Theta connectivity can be associated with the regulation of…”
ResultStatic and dynamic changes of intrinsic brain local connectivity in internet gaming disorder
Niu, X., Gao, X., Zhang, M., Dang, J., Sun, J., Yan, L., Wang, W., Wei, Y., Cheng, J., Han, S., et al. (2023) · BMC Psychiatry · doi:10.1186/s12888-023-05009-y · Cited by 27 · see citing works
“It has been linked to a variety of negative consequences such as weak time management skills, poor academic or work performance, physical and psychological disorders and social deficiencies[3–5].”
BackgroundSex differences in resting-state cerebral activity alterations in internet gaming disorder
Sun, Y., Wang, Y., Han, X., Jiang, W., Ding, W., Cao, M., Du, Y., Lin, F., Xu, J., & Zhou, Y. (2018) · Brain Imaging and Behavior · doi:10.1007/s11682-018-9955-4 · Cited by 27 · see citing works
Krishnan, A. A., & Chew, P. K. H. (2024) · Psychiatric Quarterly · doi:10.1007/s11126-024-10068-9 · Cited by 26 · see citing works
“A meta-analysis of neuroimaging studies suggested the involvement of PFC dysfunction in individuals with IGD [37].”
Khanbabaei, S., Abdollahi, M. H., & Shahgholian, M. (2021) · Personality and Individual Differences · doi:10.1016/j.paid.2021.111280 · Cited by 26 · see citing works
ADHD-Gaming Disorder Comorbidity in Children and Adolescents: A Narrative Review
Salerno, L., Becheri, L., & Pallanti, S. (2022) · Children · doi:10.3390/children9101528 · Cited by 33 · see citing works
“A key region seems to be the anterior cingulate cortex (ACC), which is known to modulate the neural activity of the default-mode network and executive control network [65] and participates in processes including cognitive control [66], the regulation of emotions [67], and reward-relative decision making [68].”
BackgroundZhang, M., & Bian, Y. (2020) · Addictive Behaviors · doi:10.1016/j.addbeh.2020.106632 · Cited by 25 · see citing works
Network-Based Analysis Reveals Functional Connectivity Related to Internet Addiction Tendency
Wen, T., & Hsieh, S. (2016) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2016.00006 · Cited by 24 · see citing works
“We identified two topologically significant networks, one with connections that are positively correlated with internet addiction tendency, and one with connections negatively correlated with internet addiction tendency.”
BackgroundYu, F., Sariyska, R., Lachmann, B., Wang, Q., Reuter, M., Weber, B., Trautner, P., Yao, S., Montag, C., & Becker, B. (2020) · Addiction Biology · doi:10.1111/adb.12933 · Cited by 23 · see citing works
Wang, Z.-L., Liu, X., Hu, Y.-B., Zheng, H., Du, X.-X., & Dong, G. (2019) · CNS Spectrums · doi:10.1017/s1092852918001505 · Cited by 21 · see citing works
“higher clustering coefficient than RGU; b (2) The IGD participants showed higher local efficient than RGU.”
BackgroundMethodResultInfluentialHakami, A. Y., Ahmad, R. G., Alsharif, A., Ashqar, A., AlHarbi, F. A., Sayes, M., Bafail, A., Alqrni, A., & Khan, M. A. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.727798 · Cited by 21 · see citing works
“Moreover, neuropathological alterations have been documented with internet gaming disorder and pornography addiction (6, 7).”
BackgroundShen, J., Zheng, J., & Zhang, T. (2023) · BMC Psychology · doi:10.1186/s40359-023-01256-6 · Cited by 21 · see citing works
“However, girls prefer casual games for their interpersonal motives, which may predispose them to emotional issues, and the gamers are more likely to exhibit anxiety and depressive symptoms [40, 81, 82].”
BackgroundAn Emerging Mental Health Concern: Risk Factors, Symptoms, and Impact of Internet Gaming Disorder
Kuriala, G. K., & Reyes, M. E. S. (2019) · Journal of Technology in Behavioral Science · doi:10.1007/s41347-019-00117-7 · Cited by 20 · see citing works
Wen, X., Yue, L., Du, Z., Zhao, J., Ge, M., Yuan, C., Wang, H., He, Q., & Yuan, K. (2025) · NeuroImage · doi:10.1016/j.neuroimage.2025.121010 · Cited by 18 · see citing works
Self-citation
- Authors
- Meng, Y., Deng, W., Wang, H., Guo, W., & Li, T.
- Affiliations
- West China Medical Center of Sichuan University (CN)
- Corresponding author
- Guo, Wanjun
- Li, Tao
- Venue
- Addiction Biology
- Publisher
- Wiley
- Published
- 2014-06-03
- Volume
- 20
- Issue
- 4
- Pages
- 799-808
- ISSN
- 1355-6215 (ISSN-L)
- 1369-1600
- OpenAlex
- W1720114320
- Cited by
- 197
- References
- 56
- Citations by year
- 2026: 6 · 2025: 10 · 2024: 14 · 2023: 13 · 2022: 9 · 2021: 15 · 2020: 59 · 2019: 16 · 2018: 16 · 2017: 15 · 2016: 11 · 2015: 11 · 2014: 2
- FWCI
- 4.33
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Addiction Biology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Nature Science Foundation of China (81130024, 30530300, 30125014)
- PhD Programs Foundation of Ministry of Education of China (20110181110014)
- National Key Technology R & D Program of the Ministry of Science and Technology of China (2012BAI01B06)
- Topics
- Social Sciences › Sociology and Political Science › Impact of Technology on Adolescents
- Social Sciences › Psychology › Clinical Psychology › Gambling Behavior and Treatments
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Keywords
- internet gaming disorder, prefrontal cortex dysfunction, medial frontal gyrus, cingulate gyrus, medial temporal gyrus, fusiform gyrus, brain activation, behavioral addiction, reward systems, self-regulation
- MeSH terms
- Adolescent, Adult, Brain Diseases, Humans, Magnetic Resonance Imaging, Male, Psychological Tests, Psychomotor Performance, Behavior, Addictive, Prefrontal Cortex, Video Games, Internet, Young Adult
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